Senior FACETS Provider Business Systems Analyst

Cynet Systems • Seattle, WA

1d

About The Position

The organization is seeking an experienced Business Systems Analyst (BSA) - Provider with deep expertise in the TriZetto FACETS Provider platform, including Provider Configuration, Network Management, and Pricing. This role will serve as a Subject Matter Expert (SME) supporting strategic Healthcare Payer initiatives, FACETS implementations, regulatory mandates, system enhancements, and upgrade programs. The ideal candidate will possess strong knowledge of FACETS Provider modules, provider network management, reimbursement and pricing methodologies, batch processes, backend data models, and advanced SQL analysis. The candidate will partner with business stakeholders, provider operations teams, architects, developers, and testing teams to deliver high-quality solutions across the provider domain.

Requirements

• 10+ years of experience as a Business Systems Analyst or Business Analyst.
• Minimum of 5+ years of hands-on experience with the TriZetto FACETS platform.
• Extensive Healthcare Payer domain experience is required.
• Proven experience supporting complex FACETS implementations, regulatory mandates, and upgrade initiatives.
• SME-level expertise in: FACETS Provider Module, Provider Configuration & Maintenance, Provider Network Management, Contracting & Reimbursement Models, Pricing Configuration, FACETS Front-End Functionality, FACETS Batch Processing, and FACETS Backend Data Models.
• Strong understanding of Healthcare Payer provider operations and network management processes.
• Advanced SQL skills with the ability to write complex queries for analysis, data validation, troubleshooting, and solution design.
• Experience analyzing provider network, contracting, fee schedule, pricing, and reimbursement business processes.
• Strong requirements gathering, business process analysis, and solutioning capabilities.
• Experience creating functional specifications, business rules, gap analysis, and system documentation.
• Excellent communication, stakeholder management, and facilitation skills.
• Ability to effectively collaborate with business, operational, and technical teams.

Nice To Haves

• Business Analysis certifications such as: CBAP (Certified Business Analysis Professional), CCBA (Certification of Capability in Business Analysis), or PMI-PBA (Professional in Business Analysis).
• Experience supporting healthcare regulatory and compliance initiatives.
• Familiarity with Agile delivery methodologies.

Responsibilities

• Serve as the primary Business Systems Analyst and SME for FACETS Provider, Network, and Pricing initiatives.
• Gather, analyze, document, and validate business and system requirements related to provider operations and reimbursement processes.
• Collaborate with business and technical stakeholders to translate provider network and pricing requirements into scalable system solutions.
• Perform impact analysis for regulatory mandates, enhancements, system upgrades, and modernization initiatives.
• Analyze end-to-end provider lifecycle processes, including provider setup, credentialing integrations, contracting, network participation, and reimbursement methodologies.
• Support FACETS implementation, migration, upgrade, and transformation programs.
• Develop business requirements documents, functional specifications, process flows, use cases, and data mapping documentation.
• Conduct root cause analysis and recommend solutions for complex provider and pricing-related issues.
• Partner with development, QA, architecture, and support teams throughout the SDLC lifecycle.
• Support User Acceptance Testing (UAT), defect triage, deployment validation, and post-production support activities.
• Facilitate stakeholder meetings, solution workshops, and business process discussions.
• Provide production support expertise for provider configuration, network management, and pricing-related issues.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed